Dear Editor,

With regard to the article on bariatric surgery in patients with morbid obesity-associated FSG,1 I would like to share with you the clinical case of a 60-year-old, obese, male patient with Alport syndrome who underwent this procedure.

Case report

This is the case of a 60-year-old male patient with Alport syndrome, microhaematuria and proteinuria 4g/day, creatinine 2mg/dl, urea 123mg/dl, moderate loss of hearing, arterial hypertension treated with enalapril 20mg, obesity and a BMI of 36.26 (weight 120kg, height 1.81m), altered fasting glucose (below 126mg/dl), normal glycosylated Hb, and dyslipidaemia and hiperuricaemia undergoing treatment. The patient was an ex-smoker who used to smoke one packet a day. His thyroid levels were normal. A kidney biopsy was carried out in 1995: OM (12 glomerules) focal and segmentary sclerosis evolving into sclerosing glomerulopathy, IF with mild intensity IgM mensagial nephropathy and IgA and IgM in tubular cylinders. EM 2 glomerules. Irregular capillary BM thickening and focal splitting of the lamina densa. Total podocyte pedicel fusion. In one sector, there was effacement of the glomerular structure with an electron dense deposit of abundant amorphous material. The alteration in the lamina densa indicated Alport disease, the rest of the findings indicated focal sclerosing glomerulohephritis. Kidney ultrasound: RK 95.6 x 52 x 53, LK 99 x 51 x 52. No abnormalities were detected in the kidney Doppler.

A low protein, low calorie diet was recommended and a 75mg/day dose of losartan was added to the treatment regimen (the maximum amount tolerated by the patient). Avery slight reduction in the level of proteinuria to 3.6g/day was observed. Gastric by-pass surgery was carried out and a total reduction in weight of 36kg was observed with the patient reaching a BMI of 25.6. Nephrological tests: creatinine 1.56mg/dl, proteinuria 0.3g/day, urea 65mg/dl and normal blood pressure with enalapril 5mg/d; the minimum dose of lipid reducing drugs was maintained, uricaemia and glycaemia were normal.

In the three years after surgery, the patient made good progress thanks to treatment adherence (diet), aerobic exercise and clinical and psychological support.